BACKGROUND Autologous bone removed during craniectomy is often the material of choice in cranioplasty procedures. However, when the patient's own bone is not appropriate (infection and resorption), an alloplastic graft must be utilized. Common options include titanium mesh and polyetheretherketone (PEEK)-based custom flaps. Often, neurosurgeons must decide whether to use a titanium or custom implant, with limited direction from the literature. OBJECTIVE To compare surgical outcomes of synthetic cranioplasties performed with titanium or vs custom implants. METHODS Ten-year retrospective comparison of patients undergoing synthetic cranioplasty with titanium or custom implants. RESULTS A total of 82 patients were identified for review, 61 (74.4%) receiving titanium cranioplasty and 21 (25.6%) receiving custom implants. Baseline demographics and comorbidities of the 2 groups did not differ significantly, although multiple surgical characteristics did (size of defect, indication for craniotomy) and were controlled for via a 2:1 mesh-to-custom propensity matching scheme in which 36 titanium cranioplasty patients were compared to 18 custom implant patients. The cranioplasty infection rate of the custom group (27.8%) was significantly greater (P = .005) than that of the titanium group (0.0%). None of the other differences in measured complications reached significance. Discomfort, a common cause of reoperation in the titanium group, did not result in reoperation in any of the patients receiving custom implants. CONCLUSION Infection rates are higher among patients receiving custom implants compared to those receiving titanium meshes. The latter should be informed of potential postsurgical discomfort, which can be managed nonsurgically and is not associated with return to the operating room.

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回复：钛网和定制植入物用于颅骨成形术的回顾性比较分析

背景技术在颅骨切除术中移除的自体骨通常是颅骨成形术中的首选材料。然而，当患者自身的骨骼不合适（感染和再吸收）时，必须使用异体移植物。常见选项包括钛网和基于聚醚醚酮 (PEEK) 的定制襟翼。通常，神经外科医生必须决定是使用钛植入物还是定制植入物，文献中的指导有限。目的 比较使用钛或定制植入物进行的合成颅骨成形术的手术结果。方法 对使用钛或定制植入物进行合成颅骨成形术的患者进行十年回顾性比较。结果 共有 82 名患者被确定进行审查，61 名 (74.4%) 接受钛颅骨成形术，21 名 (25.6%) 接受定制植入物。两组的基线人口统计学和合并症没有显着差异，尽管多个手术特征存在差异（缺损大小、开颅手术指征）并且通过 2:1 网格到定制的倾向匹配方案进行控制，其中 36 名钛合金颅骨成形术患者与 18 名定制种植体患者进行了比较。定制组的颅骨成形术感染率 (27.8%) 明显高于钛组 (0.0%) (P = .005)。测量并发症的其他差异均未达到显着性。不适是钛组再次手术的常见原因，但没有导致任何接受定制植入物的患者再次手术。结论 与接受钛网的患者相比，接受定制植入物的患者的感染率更高。